Narratives of chronic pain from armed forces veterans
This PhD thesis explores the experiences of 14 veterans of the UK Armed Forces who live with chronic pain. While there is a wealth of data exploring chronic pain in Armed Forces veterans, the existing literature overwhelmingly views chronic pain through a quantitative lens which does not explore the depth of chronic pain lived experience as a result of this; therefore, it is unclear how veterans live with and manage their chronic pain. Participants' stories of living with chronic pain were collected and analysed using dialogical narrative analysis and the analytical lens of autobiographical time, to detail veterans’ autobiographical stories of living with chronic pain, and how they use these stories to make sense of their pain experience in the context of their identity as a veteran. The analysis identifies that the participants understood and made sense of their chronic pain experience through three distinct storytelling phases. The first of these were stories of the military body, and this situated a career that was marked by physicality and the churn of life within the military institution. The second phase of storytelling was about the stigmatised body. These stories situate the attitudes toward pain and weakness within the military and the consequences of showing that the military body is infallible, which in turn inform stoic attitudes toward pain and personal pain management. The final phases of storytelling were told about the moving body, stories about the moving body were about making sense of a new body with pain, how some movement is avoided, and the consequences of this on identity. And how movement is used to understand, learn, and respond to and from their bodies on any given day. This is the first in-depth qualitative study that explores the lived experiences of veterans with chronic pain. It found that stories about chronic pain were told in the context of military experience and how the culture of the military shapes attitudes toward chronic pain, while movement was a keyway in which participants live with and manage their chronic pain.
Abstract: Background: Exposure to potentially morally injurious events (PMIEs) during military service can lead to moral injury (MI) outcomes and posttraumatic stress symptoms (PTSS). This longitudinal study examined the relationships between PMIE exposure, MI outcomes, and PTSS among Israeli combat veterans, and the potential protective role of dispositional forgiveness in these associations. Method: Participants were 169 Israeli combat veterans who participated in a six-year longitudinal study with four measurement points (T1: 12 months before enlistment, T2: Six months following enlistment- pre-deployment, T3: 18 months following enlistment- post-deployment, and T4: 28 months following discharge). Participants’ characteristics were assessed via semi-structured interviews (T1) and validated self-report measures (T2-T4) between 2019-2024. Results: Approximately 36% of participants reported exposure to PMIEs during service, with 13% exceeding the clinical threshold for probable PTSD at T4. PMIE-Betrayal at T3 was positively associated with MI outcomes of shame and trust violation at T4. The indirect effect of PMIEs on PTSS through MI outcome-Shame depended on forgiveness levels. Among veterans with low forgiveness, higher exposure to PMIE-Betrayal was associated with increased MI shame, which was linked to more severe PTSS. Conversely, for those with high forgiveness, exposure to PMIE-Self and Other was associated with decreased MI shame and subsequently reduced PTSS. Conclusion: Dispositional forgiveness moderates the relationship between PMIE exposure and MI outcomes, particularly shame, which mediates the development of PTSS. These findings highlight forgiveness as a potential target for intervention in treating moral injury and preventing PTSS among combat veterans.